Neural Response of Cervical Facet Joint Capsule to Stretch: A Study of Whiplash Pain Mechanism 2005-22-0003
Cervical facet joints are implicated as a major source of pain after whiplash injury. The purpose of this study was to investigate the proposed capsule strain injury mechanism of whiplash pain using neurophysiologic methods. Strain thresholds, threshold distribution, saturation strains and afterdischarge responses of capsule neural receptors were characterized in vivo. Goat C5-C6 facet joint capsules were used to identify and characterize capsule receptors in response to controlled uniaxial stretch by recording C6 dorsal rootlet nerve discharge. The joints were stretched at 0.5 mm/sec in a series of tests with 2 mm increments until the capsule ruptured. Ninety-two identified units were responsive to physiologic or noxious stretch while 28 were silent receptors. Among the 50 characterized responsive units, 42 showed low strain thresholds at 10.2±4.6% while 8 had high strain thresholds at 47.2±9.6%. Further, 35 of the 42 low-threshold units displayed discharge saturation at various strains (44.2±16.7%). A significant finding was that twelve low-threshold units exhibited afterdischarge for greater than 30 sec after stretch release at 36.6±12.5% strains, and displayed longer-lasting afterdischarge (greater than 4 min) at higher strains (39.0±14.4%) with significant difference (p = 0.019) in strains. Two high-threshold units had afterdischarges for greater than 30 sec or 4 min at 50.3±5.9% and 57.7±10.6% strains, respectively. In addition, the spatial distribution of the 42 low-threshold receptors demonstrated that the receptors on the joint gap were more strain-sensitive, with significantly lower strain thresholds compared to the rostral and caudal regions. No significant difference in strain threshold was observed in the medial-lateral direction. When compared to the reported strains that facet joint capsules experienced in whiplash (35–60%) and the reported capsule subfailure strains (35–67%), the low strain thresholds are substantially lower whereas the high thresholds and afterdischarge strains are within that range. Thus, low threshold units appear to signal proprioception within the physiologic range. High threshold units likely signal nociception (pain sensation) while afterdischarge may signal capsule strain injury and contribute to persistent pain.